Provider Demographics
NPI:1891147369
Name:D&E MEDICAL REPAIR SERVICE&SUPPLY STORE
Entity Type:Organization
Organization Name:D&E MEDICAL REPAIR SERVICE&SUPPLY STORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:571-970-6256
Mailing Address - Street 1:2514 S KENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-2418
Mailing Address - Country:US
Mailing Address - Phone:571-970-6256
Mailing Address - Fax:
Practice Address - Street 1:2514 S KENWOOD ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-2418
Practice Address - Country:US
Practice Address - Phone:571-970-6256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies